New research project on public health

The New Zealand Initiative is starting a new research project on public health and lifestyle regulation. As with all our research projects, we’ll be engaging with a wide range of stakeholders in the sector as part of the research process. Here’s the general brief (available in our research agenda) of what we are aiming to do:

The problem

Individual decisions around health risks like diet and exercise can cost the public purse through the public health system. Because of this, we hear calls for regulating health-related behaviours through better nutrition and more exercise. But if everything we do affects our health and could impose costs on the public purse, are there any limits to the scope of lifestyle regulation?

Our research

We will investigate the extent to which costs on the public health system constitute a real market failure – and justify regulation. We will survey the international literature to propose policy solutions targeting real market failures, but with fewer costs for personal choice.

More specifically, we’ll be looking to answer four questions:

Do costs falling on others through the public health system generate a market failure justifying regulation of individual health-related behaviours?

What does robust and meaningful cost-benefit analysis look like in this sector?

If we accept that government intervention is necessary, do current and proposed public health policies achieve what they purport to?

Are there policies or options in place that achieve public health goals, while still respecting individual choice?

This is really a call to arms for anyone who would like to engage more with our work: If this is a field you are working in/are interested in, get in touch. If there are reports/studies/evidence you would like to draw our attention to, also please do get in touch. If you’re a journalist covering this area, get in touch and we’ll make sure you receive our latest comment and press releases.

If you’d simply like to observe our research from a distance, then keep an eye on this blog, as I’ll update it with my most recent learnings and musings on the topic. In the coming months, I’ll also be writing for our weekly Insights newsletter on the topic. You can sign up for it here.

8 Comments on New research project on public health

But smoking (and all drug abuse, and addiction) also correlates with child abuse, and it seems that nicotine keeps the stress under control (repressed pain from early trauma induces a permanent stress state, that the individual must somehow manage). Nicotine is in fact a medication, albeit self-prescribed.

So would a latent hard-smoker be better off smoking, if the smoking is ultimately controlling a potentially even more severe problem?

This is a tricky territory! and I absolutely celebrate you guys going here 🙂

We need to go to original causes – and as close to the ‘origin’ as we can get.

Extending: Relating to the included video, Adverse Childhood experience (ACE’s) is a study that correlates ACE’s to later dysfunction.

But from what I know at least, these studies have not included Adverse *Infantile* Experiences.

And we know for a fact that stress in the womb has an immense impact on the developing child, and we know for a fact that circumcision, for example, makes most baby boys pass out from deep shock.

My point? If very early experiences were included in the ACE studies, then we would almost certainly discover even more striking correlations. For example, if someone got it good during infancy and birth, then you wouldn’t find they are 10x less likely than others to commit suicide and get obese, etc, you would more likely discover they are 100x less likely.

Love the idea of this research. There’s little that I could contribute that would be academically rigorous. I can contribute some thoughts though. It seems to me that most analyses in this space include a range of costs of dubious provenance, and I’d be interested in what evidence remains if those analyses are adjusted to be economically rigorous.

No doubt you’ve seen most of this, but examples would be:
– everyone has to die. People who die typically cost the health system a lot of money in their last year(s) of life. Measuring the cost to the health system of dying of a smoking or obesity related illness, without offsetting the cost of the illness you might otherwise have died of (say, dementia) is incorrect
– including personal costs – e.g. lost workdays. If lost workdays is a legitimate inclusion, then we need some sort of analysis of how many days/hours in a year someone “should” work. Do we attribute an economic cost to someone turning down a few hours of overtime when it is available? Is there some flavour of the lump of labour fallacy hiding inside here?
– including costs that are disputable – for example, costs of second hand smoke when outside, which some research suggests are over inflated

Hi Jenesa, really excited that The New Zealand Initiative is taking a relatively blue-skies approach to this topic.

It might be slightly out-of-scope, but it would be interesting to explore the extent to which individuals fail to accurately trade-off happiness now vs. happiness later. I’m of the opinion that poor discounting is a significant contributing factor to many poor health outcomes (sugar, alcohol, tobacco, whatever), and is exacerbated by the tragedy of the commons involved in a public health system. Would be very interesting to have these factors discussed.

Hi Stephen, that is absolutely within scope. It is likely to fall into the chapter where we discuss “what is a market failure?” and when does a market failure necessitate government intervention. Discounting is already used to justify a number of proposed and current health policies. We’d be (as you suggest) looking at the extent to which it is actually occurring, and even if it is occurring, whether government intervention is the best and only option.